Healthcare Provider Details

I. General information

NPI: 1780135848
Provider Name (Legal Business Name): CARLY JOY BAILEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLY JOY GENOVA FNP-C

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30680 BAINBRIDGE RD
CLEVELAND OH
44139-2282
US

IV. Provider business mailing address

9706 STATE ROUTE 305
GARRETTSVILLE OH
44231-9680
US

V. Phone/Fax

Practice location:
  • Phone: 440-542-5000
  • Fax:
Mailing address:
  • Phone: 440-487-9982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019795
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: